Lecture 4 Flashcards
What was the first Brief Solution Focused Therapy and who?
Milton H Erickson (1901-1980)
Ericksonian therapy
What was the historical context when Erickson started?
The dominant approach was a pathology-focused psychodynamic viewpoint
- long term psychodynamic psychotherapy
- Erickson specialized in medical hypnosis and family therapy
What were the key aspects of Ericksonian practice?
Short term
sometimes included hypnosis
Always involved Erickson doing something to bring about change
What were 3 hallmarks of Ericksonian practice?
1) giving homework assignments
2) engaging patients in active (sometimes metaphorical) dialogue
3) getting quick results
What were Ericksons views on pathology?
- Core q = why do people have the problem in the first place?
- Rather than viewing problems = “symptoms’ of deeper underlying pathology
- Ericksons assumption was that problems arise from the mishandling of common, everyday difficulties encountered in the course of the family life cycle
What was the Ericksonian approach?
An experiential, phenomenological approach to problem-solving utilising existing client attributes while evoking natural processes of learning and adaptation
- Ericksonian therapy is a perspective of learning, healing and growth that fosters flexibility in an ongoing, adaptive way
- Practitioners encouraged to exercise great flexibility and creativity as they work collaboratively with the client
- how progress is measured is SUBJECTIVE, and established by client relative to their goals (phenomenological)
What are 6 core concepts of Ericksonian?
1) Self-agency - elemental need to seek out challenges, strive toward meaningful goals, build adaptive future, exercise personal will in regard to ones identity, relationships and world view.
2) Tailoring: every client unique and requires tailored treatment
3) Utilization: a psychotherapeutic strategy that engages circumstances, habits, beliefs, perceptions, attitudes, symptoms or resistances in service of overarching goals of therapy
4) Naturalistic Approach: growth, learning, and freedom are inherent to all things, so during therapy people should be given the freedom to respond in a way corresponding to natural growth, learning and healing
5) Destabilisation: learning new thought/behaviour patterns requires a temporary period of destabilisation
6) Experiential living: the process of learning through experience and self-reflection, clients are viewed as experts on own experience, therapy is a discovery orientated process
What are some Ericksonian techniques?
Storytelling
Metaphors
Interspersal
Confusion technique
Catalepsy
Destabilizations
Indirect suggestions
Seeding
Truism
Utilization
Double bind
dealing with resistance
What is Palo Altos Brief Therapy Centre and mental research institute
Established in 1958 by Fisch, Weakland, Watzawick, Haley, Jackson
Investigated therapeutic approaches to rapid problem resolution
- origins Gregory Bateson (cybernetics, systems theory) and Milton Erickson (clinical hypnosis)
- Aim to move away from traditional individual psychopathology toward understanding and treating problems as an aspect of social interaction
- Model of therapy that makes no assumptions about normality or pathology and focuses narrowly on current, observable interaction around the presenting complaint
- Treated nearly 500 cases in a consistent format
What are some more aspects of Palo-alto model of brief therapy?
Non-normative - (no assumptions about normal or abnormal functioning)
- Description, not diagnosis
- Focus on how and context the undesired behavior is performed without labelling
- Complaint-based: no complaint, no problem
- Aim: resolve to present complaint quickly as efficiently as possible so they can get on with life
- Strategic intervention is deliberately minimal
- Assumption that interrupting current patterns of problem maintenance can lead to further positive developments
Assumptions about problems and change for PABT?
How a problem persists is much more relevant to intervention than how it originated
- Problems persist only if they are maintained by ongoing current behaviour of the client and others with whom they interact
If such problem-maintaining behaviour is appropriately changed or eliminated, the problem will be resolved regardless of its nature, or origin, or duration
Problem maintenance revolves around what people currently and persistently do (or don’t do) in order to control, prevent, or eliminate a complaint
Social interaction: is central to problem maintenance- the behaviour of one person both shapes and is shaped by the response of others
What is ironic processes?
Occurs: when repeated attempts to solve a problem keep the problem going or make it worse
Persist: because problem and attempted solution become intertwined in a vicious cycle, or positive feedback loop
Positive feedback loop: more of the solution leads to more of the problem, leading to more of the same solution, etc.
Problem = Positive feedback loop (vicious cycle)
BRIEF PROBLEM-FOCUSED THERAPY
Based on: identifying and interrupting ironic processes
Formulations of ironic problem-solution loops provide a template for assessment
Strategic intervention:
indicating where to look to understand what keeps a problem going (look for “more of the same” solution)
what needs to happen for the complaint to be resolved (someone must apply “less of the same” solution)
Well suited for change-resistant clients
IRONIC-PROCESS FORMULATIONS
Case specific, or idiographic
Drastically different solution patterns can (and often do) maintain the same type of problem in different cases and situations
The same solution that helps to maintain a problem in one case may actually work well for another
Limits the extent to which any standardized intervention formula can be effective for the same complaint in different interactional contexts
INTERRUPTING AN IRONIC PROCESS
Goal: to break the ironic pattern
Successful intervention: persuading at least one of the people involved to do less—or better, the opposite—of what he or she has been doing (Fisch et al., 1982)
The more the client is pushing change has the ironic effect of making change less likely
The therapist will focus on ways the client could do “less of the same”— for example, by declaring helplessness, demonstrating acceptance, or simply observing
Steps:
1. Identify the particular solution efforts that maintain or exacerbate the complaint(s),
2. Specify what less of those same solution behaviours might look like
GOAL OF INTERVENTIONS: CHANGE
Before: to prepare clients for change
During: to convey acceptance of their reluctance to change
After: to solidify change once it begins to occur
THERAPEUTIC PROCESS
1- Define the complaint in specific behavioural terms
2- Set minimum goals for change
3- Investigate solutions to the complaint
4- Formulate ironic problem-solution loops
5- Specify what “less of the same” will look like
6- Understand clients’ preferred views of themselves, the problem, and each other
7 -Use client position to interdict problem-maintaining solutions
8 -Nurture and solidify incipient change
GENERAL INTERVENTIONS
Therapeutic restraint: suggesting that clients go slow, cautioning them about dangers of improvement, and making a therapeutic U-turn (Fisch et al., 1982)
Paradoxical symptom prescriptions: prescribe the opposite action
“Go slow” messages: help to relax the sense of urgency that often fuels clients’ problem- maintaining-solution efforts, and can increase compliance with therapeutic suggestions
Applicable to a broad range of problems and to different stages of therapy
BRIEF THERAPY CENTER: PATTERN OF PRACTICE
The group meets weekly as a team and works with unselected cases
Representing a broad range of clinical problems
Maximum of 10 sessions
Primary therapist - the others consult from behind a one-way mirror
Follow up process: after treatment another team member conducts a telephone follow-up interview with the client(s) to evaluate change in the original presenting complaint
Consistent to this day, and the center’s three core members—Fisch, Weakland, and Watzlawick—all participated regularly until Weakland’s death in 1995
THE RESEARCH BEHIND: EMPIRICAL STUDIES
Research on the Palo Alto model in its pure form is rare
Evidence relevant to efficacy and effectiveness comes from:
randomized clinical trials that include strategic/ironic-process components in a broader treatment package
controlled studies of specific (usually paradoxical) interventions related conceptually to the interruption of an ironic process
Example: Leff et al., 2000, comparing 3 treatments for adult depression:
antidepressant medication,
cognitive-behaviour therapy (CBT),
systemic couple therapy that focused on interrupting problematic (ironic) patterns of couple interaction
Results:
treatment retention and outcome: systemic couple therapy was superior to the other conditions (end of treatment & two-year follow-up)
Cost: of couple therapy no greater than that of medication
